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VOLUME 25 , ISSUE 7 ( July, 2021 ) > List of Articles

Original Article

Association between Urinary Potassium Excretion and Acute Kidney Injury in Critically Ill Patients

Nadikuda Sunil Kumar, Garipalli Nikilesh Kumar, Krushna C Misra, Manimala Rao, Suneetha Chitithoti, Surya Y Prakash

Citation Information : Kumar NS, Kumar GN, Misra KC, Rao M, Chitithoti S, Prakash SY. Association between Urinary Potassium Excretion and Acute Kidney Injury in Critically Ill Patients. Indian J Crit Care Med 2021; 25 (7):768-772.

DOI: 10.5005/jp-journals-10071-23914

License: CC BY-NC 4.0

Published Online: 07-07-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Introduction: Acute kidney injury (AKI) is defined in terms of serum creatinine (SrCrt) and urine output (UO). AKI occurs in 25% of critically ill patients, which increases the risk of morbidity and mortality. Early diagnosis of AKI is challenging, as utility of biomarkers is limited. This study is the first of its kind to estimate urinary potassium (UrK) excretion and its association with AKI in an Indian intensive care unit (ICU). Aims and objectives: To study the association between UrK excretion and its ability to predict AKI in ICU patients. Material and methods: During this prospective observational study, the patient's urinary indices and renal function tests were measured on day 1 of the ICU admission. UrK excretion and creatinine clearance (CrCl) were calculated from a 2-hour morning urine sample. Association between 2-hour UrK excretion and calculated CrCl and their ability to predict AKI in the subsequent 7 days was evaluated by Kidney Disease Improving Global Outcome (KDIGO)–AKI grading. Results: Hundred patients admitted to ICU with a mean age of 53.59 ± 15.8 years were studied. The mean UrK excretion of 4.39 ± 2.52 was correlated linearly with CrCl and has a better prediction to AKI with the area under the receiver-operating characteristic curve value of 0.809 (CI 0.719–0.899), with a significant p-value (p < 0.05). UrK excretion value of 3.49 on day 1 of ICU admission had 87% sensitivity and 74% specificity in predicting AKI. Thirty-one (31%) developed AKI, of which seven (22.58%) required renal replacement therapy (RRT), with 19% of all-cause mortality. Conclusion: Diagnosis of AKI with traditional methods is not promising. UrK excretion correlates well with CrCl, which can be considered as the simplest accessible marker for predicting AKI in ICUs.


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  1. Bouchard J, Acharya A, Cerda J, Maccariello ER, Madarasu RC, Tolwani AJ, et al. A prospective international multicenter study of AKI in the intensive care unit. Clin J Am Soc Nephrol 2015;10(8):1324–1331. DOI: 10.2215/CJN.04360514.
  2. Lima C, Macedo E. Urinary biochemistry in the diagnosis of acute kidney injury. Dis Markers 2018;2018:4907024. DOI: 10.1155/2018/4907024.
  3. Vaidya VS, Ferguson MA, Bonventre JV. Biomarkers of acute kidney injury. Annu Rev Pharmacol Toxicol 2008;48:463–493. DOI: 10.1146/annurev.pharmtox.48.113006.094615.
  4. Hoste E, Kellum J, Katz N, Rosner M, Haase M, Ronco C. Epidemiology of acute kidney injury. Contrib Nephrol 2010;1(165):1–8. DOI: 10.1159/000313737.
  5. Jha V, Parameswaran S. Community-acquired acute kidney injury in tropical countries. Nat Rev Nephrol 2013;9(5):278–290. DOI: 10.1038/nrneph.2013.36.
  6. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012;120(4):c179–c184. DOI: 10.1159/000339789.
  7. Koeze J, Keus F, Dieperink W, van der Horst ICC, Zijlstra JG, van Meurs M. Incidence, timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria. BMC Nephrol 2017;18(1):70. DOI: 10.1186/s12882-017-0487-8.
  8. Palevsky PM, Liu KD, Brophy PD, Chawla LS, Parikh CR, Thakar CV, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis 2013;61:649–672. DOI: 10.1053/j.ajkd.2013.02.349.
  9. Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units–causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med 1996;24(2):192–198. DOI: 10.1097/00003246-199602000-00003.
  10. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294(7):813–818. DOI: 10.1001/jama.294.7.813.
  11. Brandt M-M, Falvo AJ, Rubinfeld IS, Blyden D, Durrani NK, Horst HM. Renal dysfunction in trauma: even a little costs a lot. J Trauma 2007;62(6):1362–1364. DOI: 10.1097/TA.0b013e318047983d.
  12. Wald R, Quinn RR, Luo J, Li P, Scales DC, Mamdani MM, et al. Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA 2009;302(11):1179–1185. DOI: 10.1001/jama.2009.1322.
  13. Brown RS Jr, Lombardero M, Lake JR. Outcome of patients with renal insufficiency undergoing liver or liver-kidney transplantation. Transplantation 1996;62(12):1788–1793. DOI: 10.1097/00007890-199612270-00018.
  14. Macedo E, Bouchard J, Soroko SH, Chertow GM, Himmelfarb J, Ikizler TA, et al. Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Crit Care 2010;14(3):R82. DOI: 10.1186/cc9004.
  15. Doi K, Yuen PST, Eisner C, Hu X, Leelahavanichkul A, Schnermann J, et al. Reduced production of creatinine limits its use as marker of kidney injury in sepsis. J Am Soc Nephrol 2009;20(6):1217–1221. DOI: 10.1681/ASN.2008060617.
  16. Yong K, Dogra G, Boudville N, Pinder M, Lim W. Acute kidney injury: controversies revisited. Int J Nephrol 2011;2011:762634. DOI: 10.4061/2011/762634.
  17. Fernández-Ruiz M, Calvo B, Vara R, Villar RN, Aguado JM. Inappropriate use of urinary catheters in patients admitted to medical wards in a university hospital. Enferm Infecc Microbiol Clin 2013;31(8):523–525. DOI: 10.1016/j.eimc.2013.02.013.
  18. Macedo E, Malhotra R, Bouchard J, Wynn SK, Mehta RL. Oliguria is an early predictor of higher mortality in critically ill patients. Kidney Int 2011;80(7):760–767. DOI: 10.1038/ki.2011.150.
  19. Maciel AT, Salles LD, Vitorio D, on behalf of the Imed Research Group of Investigators. Simple blood and urinary parameters measured at ICU admission may sign for AKI development in the early postoperative period: a retrospective, exploratory study. Ren Fail 2016;38(10):1607–1615. DOI: 10.3109/0886022X.2016.1144162.
  20. Saha H, Mustonen J, Helin H, Pasternack A. Limited value of the fractional excretion of sodium test in the diagnosis of acute renal failure. Nephrol Dial Transplant 1987;2(2):79–82. DOI: 10.1093/oxfordjournals.ndt.a091519.
  21. Smyth A, Dunkler D, Gao P, Teo KK, Yusuf S, O'Donnell MJ, et al. The relationship between estimated sodium and potassium excretion and subsequent renal outcomes. Kidney Int 2014;86(6):1205–1212. DOI: 10.1038/ki.2014.214.
  22. Shankel T, Shankel S. Urinary sodium/potassium ratio in acute kidney injury accurately differentiates prerenal azotemia from acute tubular necrosis. Acta Med Marisiensis 2019;65(3):103–110. DOI: 10.2478/amma-2019-0011.
  23. Murray PT, Devarajan P, Levey AS, Eckardt KU, Bonventre JV, Lombardi R, et al. A framework and key research questions in AKI diagnosis and staging in different environments. Clin J Am Soc Nephrol 2008;3(3):864–868. DOI: 10.2215/CJN.04851107.
  24. McIlroy DR, Wagener G, Lee HT, Riou B. Biomarkers of acute kidney injury: an evolving domain. Anesthesiology 2010;112(4):998–1004. DOI: 10.1097/ALN.0b013e3181cded3f.
  25. Maciel AT, Park M, Macedo E. Physicochemical analysis of blood and urine in the course of acute kidney injury in critically ill patients: a prospective, observational study. BMC Anesthesiol 2013;13(1):31. DOI: 10.1186/1471-2253-13-31.
  26. Prowle J, Bagshaw SM, Bellomo R. Renal blood flow, fractional excretion of sodium and acute kidney injury: time for a new paradigm? Curr Opin Crit Care 2012;18(6):585–592. DOI: 10.1097/MCC.0b013e328358d480.
  27. Maciel AT, Park M, Macedo E. Fractional excretion of potassium in the course of acute kidney injury in critically ill patients: potential monitoring tool? Rev Bras Ter intensiva 2014;26(2):143–147. DOI: 10.5935/0103-507X.20140021.
  28. Toledo Maciel A, Vitorio D, Delphino Salles L. Urine sodium profile in the course of septic acute kidney injury: insights relevant for kidney function monitoring. Minerva Anestesiol 2014;80(4): 506–507 PMID: 24226498
  29. Maciel AT, Park M, Macedo E. Urinary electrolyte monitoring in critically ill patients: a preliminary observational study. Rev Bras Ter intensiva 2012;24(3):236–245 PMID: 23917824.
  30. Burns AR, Ho KM. Urinary potassium excretion and its association with acute kidney injury in the intensive care unit. J Crit Care 2018;46:58–62. DOI: 10.1016/j.jcrc.2018.04.009.
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